Julia Bueno - 2 July

It is commonly estimated that one in four pregnancies fails to thrive, and ends spontaneously in a miscarriagemost before they have been revealed to the world, or even suggested by the hint of a pregnancy bump. This can be devastating, extremely physically painful, or both. And yet despite its prevalence, we have been long unable to talk about miscarriage in any adequate breadth or depth. If we do, we tend to do so awkwardly, quickly, and in the most general terms. We squirm, we whisper, and we avoid asking questionswe just dont understand the experience well enough or the nature of the complex grief that can hit hard in its wake.

But miscarriage deserves so much more than these scant responses it tends to elicit. We need to approach this human experience with greater empathy and an allied compassionate curiosity so that, ultimately, we can improve the support thats on offer for all of those who may be affected. I began to learn this in the wake of my own miscarriages: my first one profoundly changed me, inspired a new career, and still fuels my desire to change how miscarriage is perceived.

The inklings of my future family began when I was eighteen years old and met my now husband, David, on my first day of college. He and his friend had spotted me walking through the swing door of a building near their rooms, on my way to visit a friend. I later found them both lying on the ground, blocking my exit. I laughed, we all talked, and then the friend peeled off, leaving David and me to talk some more. Later that night David introduced me to Van Morrison, and by the time I returned to my room, I knew that I wanted to spend the rest of my life with him. It took another year before he agreed.

We both wanted children, but parenthood wasnt on the agenda for a long time. While David fell into journalism soon after graduating, I flirted with academia and then a legal career, before moving to an internet start-up. But after a decade together, we had bought our first home in London and were planning a wedding. Having a baby seemed like the next step, and as soon as David agreed to try, a baby was all I wanted. And I wanted it to be like the story I knew the best: Id get pregnant before too long, grow fat and uncomfortable, and then give birth to a little version of him and me.

But this story would never be told. For us, things took a different turn from the beginning. I had spent many years ignoring my irregular menstrual cycle, disguising what I suspected was a minor fertility issue with the synthetic hormones of the contraceptive pill. When we first discussed trying to conceive, we consulted my sensible general practitioner, who sent me for further investigations. I assumed if anything was awry, there would be a simple fix.

After a scan revealed some unusual findings, I was sent for a laparoscopya tiny fiber-optic cable was inserted through my abdomen wall to inspect the state of my womb and ovaries. An hour or so later, as I awoke from my drugged sleep of general anesthesia in the recovery ward, my surgeon appeared, his wild white hair only partly tamed by a surgeons cap. He excitedly reported what the camera had revealed: I have a unicornuate uterusa malformation that means my uterus didnt fully develop when I was in my mothers womb. It is, in keeping with the medical inclination to describe wombs as varieties of fruit, shaped like a banana, rather than the avocado Mother Nature prefers.

My surgeon also told me that while I had two functioning ovaries, I now had only one fallopian tube; the other was barely developed and useless, so he had removed it during the procedure. He handed it to me in a small plastic jar: a gray gnarled lump of flesh. Baffled at my gift, I was also soothed by the promise of a healthy counterpart. At a follow-up appointment a month later, he was upbeat about my prognosis to conceive and carry a baby to term. My anomalies may have explained my irregular menstrual cycle, and he glossed over the increased risk of pregnancy loss or premature delivery that my abnormal womb could potentially cause. He told me gripping stories of other strange-shaped wombs that had resulted in happy deliveries. I left his consulting room buoyant and with a renewed sense of expectation: an experienced doctor thought a pregnancy could, and would, happen for me.

It took about a year of hopes raised and then dashed before I conceived. I was so consumed with my desire to get pregnant that it eclipsed everything else, including our wedding. I didnt care about the details of my dress or which flowers to choose as much as the repeated arrival of my period. But, at long last, a couple of months before my thirtieth birthday and ten months after our wedding, my familiar bleeding didnt arrive, and I took my first pregnancy test. I still have the white plastic wand that proved I had conceived the baby (and, it turned out, another baby) that had long been nestled in my mind.

It was only a couple of weeks after my pregnancy was confirmed that our joy was punctured by fears. First, I started to spota common experience of light bleeding in early pregnancy that can be caused by the embryo implanting itself in the womb lining. A scan at the hospital at around six weeks revealed this was probably the case with me, but it also revealed two minuscule humans with beating hearts: I had conceived twins. Growing two babies inside a banana-shaped womb within my five-foot frame was never going to be easy, but I remembered the words of my surgeon. And I hoped.

The coming weeks brought even more anxiety: I had bouts of sudden and heavy bleeding. More scans showed that a sizable hemorrhage had formed in my womb lining and was struggling to heal. I was told that this was probably because my womb had stretched too rapidlynot unheard of with first pregnancies of twins. I became a frequent flyer of the high-risk pregnancy unit, led by an obstetrician with legendary expertise in twin pregnancies. I bled copiously, and often, throughout the following ten weeks, while also battling intense and relentless nausea that made it difficult to eat. And while our frequent hospital visits assured us that our babies were thriving nonetheless, there were few moments during my first trimester when I could relax into my dreams of a future family of four.